Health and Care Bill

Anne Marie Morris Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Anne Marie Morris (Newton Abbot) (Con)]

I thank the Minister for the time he gave me to consider my amendments, which we discussed in some detail, and I thank Her Majesty’s Opposition who, very kindly, took some of my amendments through Committee, sadly unsuccessfully. Tonight I hope to have the opportunity myself to explain why these amendments are so important. Before the House thinks, “Oh my goodness, how can we possibly deal with that many clauses and amendments?” let me say that I will endeavour to be brief. I rise to speak to new clause 33, and amendments 21, 22, 19, 16, 17, 20, 18 and 23—but I will be brief.

Let me divide my remarks into four topic areas: domestic abuse, mental health, access to medicines, and research. New clause 33 deals with domestic abuse. That is a horrific crime. It is insidious, it is hidden, and it is on the rise, and during the pandemic it has, sadly, grown from strength to strength. I say, pointedly, that this is a hidden crime, and at the moment, all the teeth are with the police. However, the police can deal only with very evident crime.

Where does domestic abuse first appear? It is in a doctor’s surgery, or at accident and emergency. To date, however, there is no obligation on clinical commissioning groups, integrated care boards or hospitals to come up with a strategy to address that horrific ill. New clause 33 would place a new obligation on ICBs to put in place a proactive strategy to properly manage that issue, and to introduce the education and training that GPs and those in hospitals and A&E need. We must ensure that we no longer find, as in the Safelives report, that those experiencing domestic abuse will have experienced it for three years before it is picked up, despite having already been to visit their GPs almost five times. I do not believe that that is acceptable in a civilised society such as the one we have today.

Five and a half per cent. of adults between 16 and 74 experience such abuse, and the Home Office has determined that the cost of that was £66 billion in 2016-17. Of that, £2.3 billion was the cost to the health service. We know that 23% of those who are at risk attend A&E, and yet nothing happens. I am fortunate that in Devon we have a pilot. My CCG is the only one in the country to have a dedicated individual on the board who specifically oversees and sets a dedicated strategy on this issue. The estimate from the pilot so far reckons that if we spent £450,000 a year on our GPs in Devon, we would get a return of £7 million. But this is not about money; this is about what is the right thing to do. Until this measure is on the statute book, and until there is an obligation to put in place a strategy, this will not change, and I cannot sit here and accept that.

Let me turn to mental health. For many years and in many documents, we have seen a commitment to parity of esteem, but I have been through every statute on the book and at no point is there any reference to the words “parity of esteem for mental health”. If parity of esteem for mental health is not on the statute book, how can we say we believe in it? If it is not on the statute book, how can we possibly measure it? Currently, there are very few measures of inputs or outputs—or, worse, of outcomes —for those going through the mental health system. There are some, but they are minuscule compared with what we have for physical health.

Amendment 23 to clause 19 would require each ICB to compare the inputs and outputs on physical health and mental health. Each ICB would be required to set out: the number of patients presenting with physical symptoms and with mental symptoms; the waiting times for initial assessment in physical health and in mental health; the waiting times for treatment in physical health and in mental health; the number of patients actually receiving treatment in physical health and in mental health; and, finally, reports on readmissions. I know that Ministers do not like that level of detail, but how important is this? Without some very specific measures, it will not happen. What gets measured generally gets done.

Amendment 23 would also require the ICBs to report against the very few national standards that there are. At least then we would see what they were; we would shine a bright light on the fact that there are so few for mental health while there are numerous for physical health. The Secretary of State would be required to consolidate those reports into a national report, which would have to be presented to Parliament—to both the Commons and the Lords. What is there for Ministers not to like about that amendment? What is there for those on the Opposition Benches not to like about it?

[Jonathan Ashworth]

We like it!

[Anne Marie Morris]

Then I would like to see you wishing to press it to a vote and putting your vote—and your feet—where your mouth is. [Interruption.] I apologise, Madam Deputy Speaker; it is not your mouth. I was carried away by an overwhelming desire to get my point across, and I apologise most profoundly.

I turn to access to medicines. Most Members believe, do they not, that medicines that have been approved by the National Institute for Health and Care Excellence are available to all our constituents? The reality is that they are not. A medicine may have gone through the Medicines and Healthcare products Regulatory Agency and been proved to be safe, and through NICE and been said to be cost-effective, but each CCG—each ICB, as they will be—and hospital trust, and every other NHS body responsible for prescribing, sets its own formulary, and those formularies do not include all NICE drugs. If a medicine is not on the formulary, then no consultant or GP will be able to get reimbursement, so they will not be allowed to prescribe it.

In my constituency, a number of individuals have come to me because they cannot get access to a particular medicine, yet people in another constituency can. I do not believe that a postcode lottery is right. We all talk about the NHS, and health and care, being free at the point of delivery, and we all assume that we can get access, whether to GPs or to hospitals, but I do not think it occurs to most of us—it had not occurred to me—that we cannot necessarily get access to medicines.

My amendment 21 to clause 15 would effectively oblige every ICB, where any individual patient has the advice of their clinician that they should have a particular medicine and it has been approved by NICE, to make provision to ensure that that medicine is provided—perhaps from a neighbouring ICB, taking advantage of the duty to collaborate across ICBs. That would ensure that even if a medicine was not on the formulary in the area of an individual ICB, it could be obtained from another area. Bear in mind that there is no financial loss in doing that, because all NICE-approved drugs are subject to a voluntary pricing agreement between the pharmaceutical companies and NHS England. Under that agreement, x number of drugs will be provided at an agreed cost. Anything above that will be reimbursed by the drug company, so the Government and the NHS will not be out of pocket. Why would that not be a good clause? To provide belt and braces, under amendments 20 and 22, all NICE treatments would automatically be added to all formularies within 28 days of market authorisation and every ICB would be obligated to report.

My last area—I will be very brief, Madam Deputy Speaker—is research, which is so important, as we discovered during the pandemic. I would like to draw the attention of the House to some of the challenges. Some of the anti-viral solutions to coronavirus were late to market because we could not get the clinical trials. Why? Because we could not get access to the records of the patients who had had covid or been diagnosed with covid so that we then had the appropriate cohort to be able to test the anti-virals. It therefore seems very clear that research must be taken on board across every hospital trust and across every ICB. If every ICB and hospital trust had in place a system to ensure research was part of their DNA—that they had to report on what research they were undertaking and had an obligation, if they were asked and had the appropriate cohort, to recruit the patient base so that particular clinical trials could take place—we would get more medicines faster to market. I think most people would say that that was a win.

[Rob Roberts (Delyn) (Ind)]

I declare an interest in that my partner is a clinical research nurse—working in cardiac research—so I completely appreciate and understand exactly where the hon. Lady is coming from. Does she agree that to find patients for studies, often tens of thousands of pounds is spent on radio and online adverts? If her amendment 17 is successful, it could be revolutionary for research in this country.

[Anne Marie Morris]

I thank the hon. Gentleman. He is absolutely right. If we could have this new system, so there was a research strategy and an obligation to consider clinical trial requests and then report, we would be in a very different place.

Madam Deputy Speaker, you have been incredibly indulgent and so have all hon. Members. On that note, having had my time for my four areas, I thank the House for its indulgence and I look forward to the Minister’s reply.

NHS Update

Anne Marie Morris Excerpts

Wednesday 21st July 2021 Commons Chamber

[Helen Whately]

I do not accept what the hon. Gentleman says. From my position during the pandemic, I can say that we have tried, at every step of the way, to protect those who have been most vulnerable to this virus. It is a cruel virus, and it is particularly cruel to those who have weaker immune systems and those who are older. We have done all we possibly can, including putting over £2 billion of funding, PPE, testing and vaccinations into social care to do our utmost to protect those who are most at risk.

[Anne Marie Morris (Newton Abbot) (Con) [V]]

The pandemic has shown the vital need for effective collaboration across health and social care, and the need for individuals, such as nurses, to be able to work flexibly across both systems. What steps have the Government taken to ensure that parity of esteem is achieved across the health and social care workforce, in their training—preferably together—in their work opportunities and in their pay, which should be comparable?

[Helen Whately]

My hon. Friend makes an important point, and we have seen some really effective collaboration across health and social care during the pandemic. We want to continue to build on that. One of the things I am doing is working with Health Education England, which is launching a review looking ahead at how we can go further in bringing together our healthcare workforce and registered staff in the social care workforce.

Health and Care Bill

Anne Marie Morris Excerpts

2nd reading
Wednesday 14th July 2021 Commons Chamber

[Anne Marie Morris (Newton Abbot) (Con) [V]]

I welcome the Bill, and I particularly welcome its aims and objectives to provide the best possible health and care to everyone in this country. However, to achieve that, things must change in the legislation. It must have explicit provisions for mental health, not just physical health. It must also include provisions for children’s social care, not just adult social care, and provide for the commissioning of not just medical services, doctors, nurses, infrastructure and hospitals but medicines and devices, which we know have been crucial in the fight with covid.

How are we going to do that? First, we need to include parity of esteem clauses—one for mental health and one for social care. We need to define what we mean by parity of esteem, which will be a first: what are we going to put in? Not just money; what processes will we promise to deliver? What healthcare outcomes are we looking to deliver? We need the same for mental health and social care—both are deserved.

As others have said, we need a proper workforce plan, but it must cover not just health but social care, and it must look specifically at how we will deal with recruitment. How will we deal with the career path in future? How will we look at training and retention for the future? There should be an integrated plan, not one for health and one for care. Our nurses, for example, work across both systems.

We need to provide for the commissioning of medicines and devices. Currently, it is a postcode lottery. The previous legislation on medicines and devices covered licensing, but not commissioning. Patient choice depends upon forming that system so that everyone gets access to the medicines approved by the National Institute for Health and Care Excellence. Currently, that is not the case.

We must positively review the big-picture strategy. What do we need? What are the skills we need for health and care? We must look broadly, not narrowly. We must look at what greater role our pharmacists can play. How can we improve our training so that people have more general skills that we can use in a pandemic such as this, so that everyone in the health system can be used? To support that, we will need to rework the membership provisions for the ICBs and the ICPs. We will need to amend the data regulations to ensure that they can go beyond the boundary of the NHS, and we will need to look at our medicines directory—the sister of the devices registry—to ensure that it includes information from research through to patient experience. There is much to do; it can be done. Where there is a will, there is a way.

Children and Young People’s Mental Health

Anne Marie Morris Excerpts

Wednesday 16th June 2021 Westminster Hall

[Anne Marie Morris (Newton Abbot) (Con) [V]]

It is a great pleasure to serve under your chairmanship, Sir Gary. The issue of children and adolescent mental health is mission critical. It is the next tsunami—the challenge that will follow the covid pandemic. Now is the time not only to right historical wrongs—they are not as simple as underfunding; it is about truly looking at parity of esteem—but to look at the increasing needs that young people, and adolescents in particular, face and need to be satisfied.

We sometimes forget that mental ill-health is as much of a killer as physical ill-health. Life expectancy for those with mental health problems is usually reduced by some 10 years. Clearly, that can get worse in some areas and mildly improve in others. One of the real challenges is that it is those in deprived areas and lower-income families who suffer the most. Sir Gary, you will be aware of the huge deprivation in our rural areas, which is sadly hidden and therefore not properly addressed.

To get this right, we need properly to monitor it. We need to be clear what we mean by mental health. We need to be clear what illness means. We measure diagnosis, but there are many problems that come before it. We heard earlier from hon. Members that the time gap between someone putting themselves forward with a potential problem and diagnosis can be significant. We need to recognise that both have to be addressed.

The point that has been made about data is right. If we do not understand who is coming forward within the three systems—education, health and local government—what hope do we have of really understanding the scope of the problem? We need to collect, measure and keep consistent data across the country about diagnosis, waiting times, treatment and recovery. It is not just about what we put in to address mental health; what happens at the end of it—whether people get better—is equally important. Unless we do that, this promise of parity of esteem is never going to be delivered.

Some of the existing targets, which in my view are not adequate, are distinctly unambitious. The access target for children and young people is 35%. That seems the wrong way around—surely it should be the larger part, not the smaller part.

We must remember when we talk about youngsters that children are the most vulnerable to mental health problems, and an earlier contribution set out exactly what the statistics look like. I pay tribute to Devonshire Partnership NHS Trust in my area, which has done a fantastic job of providing support against all odds, but the numbers are growing. The eating disorder challenge is going exponentially upwards. Quarantined children are showing acute stress disorder and acute adjustment disorder.

Addressing the waiting time issue is just the start of solving the problem, but let us at least look at it and try to find a proper target to collect data for and monitor, with some sanctions if it is not met. In 2017, a four-week waiting time was piloted, but it was only a pilot and has not been rolled out across the country. We know from our own experience around the country that the actual waiting time can be significantly greater. My call today is for a national access and waiting time standard. It is much needed and would be the start of our journey towards true parity of esteem.

The pandemic has had a huge impact on youngsters. Many—up to 25%, it is estimated—are not getting the treatment that they have been given historically. We also know that the numbers have grown enormously. They will just add to the burden. Although the Government have provided support, it is not yet enough.

My ask is this. We need to look again at the health and care Bill, and at specific provision for mental health. We need to look at specific provision for how it is commissioned, and at proper measurement to deliver parity of esteem. We need national access and waiting time standards. The five year forward view for mental health has not been met; it must be. Mental health matters. Young people matter. What gets measured gets done.

Teignmouth Hospital

Anne Marie Morris Excerpts

Tuesday 9th March 2021 Westminster Hall

[Anne Marie Morris (Newton Abbot) (Con) [V]]

I beg to move,

That this House has considered the future of Teignmouth Hospital.

It is a great pleasure to serve under your chairmanship, Sir Charles. This is the story of a hospital being closed by stealth. Teignmouth Hospital, which is in my constituency, was built in 1954. It was one of the first purpose-built NHS hospitals and offered a wide range of services. Even today, it has three community clinics, in audiology, physiotherapy and podiatry, which have largely been funded by the League of Friends. In addition, there are out-patient clinics dealing with abdominal aortic screening, anaesthetics, breast, cardiology, chronic fatigue—there are 23 of them in total, so I will not labour through all of them, in the interests of time and to allow a proper discussion of this issue. The hospital also has an operating theatre, which takes day cases relating to eye complaints and skin issues.

However, all of this was put into a quandary in 2014, when the local clinical commissioning group decided to look again at how health and care should be properly provided in Teignmouth and Dawlish. That is absolutely the right thing to do. However, my issue is with how it has been done, and with the evidence that has been collected and the way it has been evaluated.

The consultations took the following steps. First of all, they looked at removing two of the in-patient wards within Teignmouth Hospital. So, at a stroke in 2016 and after two consultations—one in 2014-15 and one in 2016—a decision was made to remove two whole wards. As anyone can imagine, the local community were not at all happy and the only thing that helped was the promise of 12 new rehabilitation beds to help in the community. That would have been very appropriate in a rural community with an ageing population, which mine is, and with a state-of-the-art physiotherapy unit paid for, as I have said, by the League of Friends. However, what was even worse was that those rehabilitation beds were never delivered. A unilateral decision was then taken in 2017 that there would be no rehabilitation beds. No evidence was produced and no consultation took place.

Then, in 2018 a further consultation looked at a reconfiguration of services. The creation of a new health hub, which was the core proposal, was and remains absolutely the right thing to do, and is in accordance with the NHS Long Term Plan. It would house the GPs in Teignmouth and an integrated care hub, with individuals from the voluntary sector, and the three community clinics. However, the out-patient clinics—all 23 of them—were to be relocated to another hospital in Dawlish. It is not that far away, but given our transport problems it is quite far enough away to be problematic for an ageing population.

The consequence suggested—but with no questions asked—because of the hub and the relocation of services to Dawlish, was that Teignmouth Hospital would necessarily close. There was no consultation. It seems to me that although there has been a consultation on reconfiguration, there has been no consultation on a hospital closure. It is my understanding that legally—never mind to ensure best care—such a consultation should take place.

I and a number of colleagues were very disquieted by all this. Indeed, the health scrutiny committee at Devon County Council was sufficiently concerned about the lack of evidence and the failure to consult that it went to the reconfiguration panel to take informal advice as to what it should do. It is only the health scrutiny committee, under current legislative provisions, that can, in effect, call in such a decision. It is my belief that, had it done that formally, the reconfiguration panel would have had to take a much more serious approach. Instead, its response to the request for advice was, frankly, a bit of a pat on the head: “Go and talk to the clinical commissioning group; I’m sure you can resolve your differences,” or words to that effect. I do not really think that is a responsible reply to a very urgent and well meant request for assistance, and my view would be, in the light of that response, that the county council, through its scrutiny committee, should now make a formal application.

The issue is that Teignmouth Hospital is to close, without any consultation at all. Why does that matter? It matters because there has been no assessment of the health and care outcomes for residents of Teignmouth. Without such a consultation, how can we be clear that health and care needs are being properly met? Worse, the consultation takes no account of what is happening in the landscape of social care. In Teignmouth there are no nursing care homes, so there is no fall-back; there are no other beds in the community that can be used.

Why are the health scrutiny committee and I so exercised about the flaws in the reconfiguration, which mean that closing Teignmouth Hospital without consultation is a real mistake? First, the decision is based on an assumption that all intermediary care can be undertaken at home, with the balance in nursing care homes. I contend that it is simply unrealistic to consider that all intermediate care can be undertaken in an individual’s home. There are lots of reasons for that. First, we do not have any nursing care homes in Teignmouth. Secondly, even if we did, rehabilitation is not what nursing homes are all about. Thirdly, some of these elderly people have to have help come to them from some distance, which makes it a challenge. We also have an acute lack of domiciliary care provision. That puts a very big question mark over the key assumption that underpins all the decision making.

The evidence that was presented is inadequate in quality and in quantity. There was a lot of data; I am drowning in data, but I have very little genuine information and very little genuine analysis. On that basis, I am very unhappy with what I have seen. It is fundamentally desk-based research by the clinical senate and the University of Plymouth—two outstanding institutions. However, the information that they have used is simply records of beds and their use, whether in a hospital setting or otherwise. It looks at discharge and delayed discharge, but because there are no beds at the moment in Teignmouth Hospital, there is nowhere for people to go other than home, or a care home outside Teignmouth, so is it surprising that we find an argument being made that those beds that were in Teignmouth Hospital are not needed? It seems to me that a negative cannot prove a positive.

Of more concern is the fact that there is no research whatever on the patient experience. Given the lack of domiciliary care provision, that is a crucial omission. People should bear it in mind that, at this point in time, the hospital’s beds have been closed for two years. Why has no evidence been gleaned as to the quality and quantity of the care provided to people in their homes? That seems to me a glaring error, which must be resolved.

It also seems to me that the evidence is definitely defective. It takes no account of this new, post-covid world. I accept that the consultation started before covid, but it has lasted through covid, and for me that has made one thing clear: the old system we had, which was very much just in time, is no longer the way forward. We must have a resilient care system. That means taking into account the impact of covid. We know long covid is following covid. We know that that specifically requires a lot of rehabilitation care. I raised that with the clinical commissioning group, who believed it was inappropriate to take account of the figures for 2020-21 because those covid figures were unrepresentative. I find that strange, because, if those are unrepresentative of the real need, surely the figures for 2019 are equally not representative. That causes me real concern.

I will turn to the proposal in relation to the other services, not beds in Teignmouth Hospital. That care is to continue to be provided in Dawlish Hospital. Dawlish is, effectively, to take double the number of referrals—23 out-patient clinic patients on top of its existing load of patients. The “building works”, which I would not really call building works, will simply reconfigure the maternity room into two consulting rooms. It is a bit like moving the deckchairs on the Titanic. There is no evidence of any real effort to ensure that Dawlish is properly configured to meet what will be an increasing demand.

As for the hub itself, there is no evidence that it will have the capacity to take all the GPs, all the community service clinics, the integrated care hub and the voluntary sector representatives. Yes, planning permission has been put in for and, indeed, granted. It is clear how the rooms will be configured in the new hub, but not how they will be used, and until they are used we simply do not have evidence that they will be sufficient for the need.

What is the way forward? It seems to me—because we have two years during which the hub is to be built—that the first priority is to collect the missing data. Let us collect the data for 2020-21, and look properly at bed occupancy and why it is as it is. Let us look at discharge, readmissions and waiting lists. Let us look particularly at the impact that long covid will have in that period on rehabilitation care and growing need. Let us also undertake some research on the quality and quantity of home-based care. There is no evidence about either of those in anything that has been presented by the clinical commissioning group. Worse, there is nothing on the patient experience at all. When all the data has been gathered, let us have a separate consultation on Teignmouth Hospital—not only after the data has been gathered but after the hub has been opened and we can see whether it is adequate, and Dawlish has taken on its additional work.

To be clear about the impact of the reconfiguration on Teignmouth residents, all those things must be taken into account. That is right and responsible. If we get the decision wrong, we could well find that we are closing a facility only to spend money on reopening something else to meet the rehabilitation need that is not met. That is lose-lose. I would be the first to agree that it is an ageing hospital, but it could be improved—not to become state of the art, and I am not looking for that; but it would cost just over £600,000 to get it to a position where it could continue to provide the services that are needed.

My ask of the Minister and the Secretary of State is, first, to intervene to stop this automatic closure of Teignmouth Hospital, as the Secretary of State did to stop the closure of Chorley hospital accident and emergency department in Lancashire. I quote regional director Bill McCarthy:

“We have received instruction from both the secretary of state for health and the minister of state for health, to work with the integrated care system and local leadership to develop an option that provides safe, high quality care, that continues to include Chorley”

emergency department. That was reported in “North by Northwest” in February this year, not many weeks ago.

I do not have an opinion as to whether that was the right decision, but the Secretary of State said expressly in the very recent latest White Paper—which will lead to an NHS Bill—that he intends to enable power to be given to him to call in decisions such as the Teignmouth one and to remove the reconfiguration panel. From the experience I have had, that panel is not fit for purpose.

My second ask is that the Secretary of State and the Minister instruct the reconfiguration panel that no closure of any hospital or facility should be made going forward without the impacts of covid having been taken into account and a proper impact assessment having been made.

My third ask is for the Secretary of State and the Minister to instruct the clinical commissioning group to put in hand a separate consultation specifically on the closure of Teignmouth Hospital, after the data I referred to have been collected, and to mandate the CCG to collect the necessary evidence on patient experience, on the impact of Dawlish Hospital and on the adequacy of the new hub at Teignmouth. The group should then review the data collected and analyse it properly.

Teignmouth Hospital deserves better and the people of Teignmouth deserve the Secretary of State’s support. I ask the Minister in his place to grant that support and to do what he and the Secretary of State are more than capable of doing, so setting an example of how important health and care are to him and to us. That would set a marker that covid has changed the game and that covid, and long covid in particular, must influence and guide future decisions on hospital closures. I thank you for your indulgence, Sir Charles, and I look forward to the Minister’s response.

Future of Health and Care

Anne Marie Morris Excerpts

Thursday 11th February 2021 Commons Chamber

[Matt Hancock]

There is a simple, clear reason for that, and I am very glad that the hon. Lady asks that question, because it is an incredibly important function. We will set out more details on the arrangements for health improvement functions, but the population health approach that is embedded within the integrated care systems set out in the White Paper will itself be at the fulcrum of delivery of health improvement and of narrowing health inequalities. If we think about it, around 20% of the impact on someone’s health is what happens in hospital; the rest is what happens outside hospital, the extra support that people can get and, of course, the choices that people make. Integrated care systems will be supported and funded in such a way that their goal is to improve the health of the local population, not just of the patient.

Health improvement is embedded in the structure and the design of the future of the NHS embedded in the White Paper, and the wider health improvement responsibilities will flow from that. We will set out the precise organisational structure of those shortly, but I needed to get the White Paper out first, because it is off this population health approach that the future of health improvement will be built.

[Anne Marie Morris (Newton Abbot) (Con) [V]]

I welcome the commitment to more joined-up care, which must include mental health. The Health and Social Care Act 2012 committed to parity of esteem between physical and mental health. Will the Secretary of State set out how, specifically, the White Paper builds on that? Will it require and measure parity of esteem in output, and particularly outcomes, for mental health? If not, why not?

[Matt Hancock]

I am grateful for my hon. Friend’s support. Parity of esteem between mental and physical health is critical, and of course it is embedded in a population health approach. It is critical that the new integrated care systems will of course have responsibilities for provision of mental health services as well as physical health services. The historical silos in the provision of mental health and physical health services need to be brought together; so often, the provision of both is critical in a world in which many people have multi-morbidities, including challenges with both their physical and their mental health.

Covid-19 Update

Anne Marie Morris Excerpts

Thursday 15th October 2020 Commons Chamber

[Matt Hancock]

We are seeking to publish further evidence on the impact of measures. For instance, I have often mentioned Leicester and Bolton—in Bolton, the curve was flattened and in Leicester we brought it down with a much stricter intervention than the one we are proposing in London. We are proposing to publish further information on the analysis of the impact of such measures.

The fundamental science is really simple: the more people congregate, the more the virus is passed from one to another. That is why the restriction of social activity between households indoors is an important part of restricting the spread of the virus. All those areas in level 2 are reviewed fortnightly. Of course, if we can bring any area, including London, out of level 2 faster, that will be even better. I am working with the cross party London councils and the Mayor on setting out more details about how London can exit these measures and get down to level 1. Ultimately, of course, and as soon as possible, we all want to get to level zero, which is normal life.

[Anne Marie Morris (Newton Abbot) (Con) [V]]

Will the Secretary of State please explain what formal and detailed assessment his Department has made of the long-term health cost that a second blanket lockdown would have on the physical and mental—not just covid-related—health of the population, and whether he believes that that is an acceptable trade-off?

[Matt Hancock]

I have looked into this in great detail, as my hon. Friend will imagine, as she is experienced in these areas. The result of what I have looked at is that there is no trade-off. If covid gets out of hand, that increases non-covid ill health and non-covid deaths too. When it comes to mental health, I was talking only yesterday to the Royal College of Psychiatrists, who are clear that a second peak getting out of hand is bad for mental health, not least because of the mental health impacts of long covid for people who survive covid but for whom the condition lasts for months and months, which is an issue very close to my heart. A proposition has been put forward that there is some trade-off between covid health and non-covid health, but I have looked into it in great detail and it is false. The best way to improve the non-covid health of the nation is to ensure that covid says under control.

Independent Medicines and Medical Devices Safety Review

Anne Marie Morris Excerpts

Thursday 9th July 2020 Commons Chamber

[Ms Dorries]

The hon. Lady is absolutely right in everything she said, and I completely agree with her, 100%. My team of officials and I, from the very first day that I arrived in the Department, have been looking at a women’s agenda and at the way that in so many areas of healthcare there does appear to be an unintentional bias. I am not saying that it is intentional and I would not particularly use the word “misogyny”, but there is an unintentional bias. It is proven by the amount of time it takes for women to have their voices heard and for their complaints to be taken seriously and yes, addressing that is absolutely a priority. The problems that women were subjected to and the prolonged pain they experienced simply because their voices were not being heard is something that we will have to address in our response. That bias against women must surely be obvious from the amount of inquiries that we are having about women-only issues, and I hope that highlighting that, bringing it here and not being afraid to ask for inquiries where we see that bias taking place, is like shining sunlight on it—to quote someone long before my time. It is only by opening up these issues, allowing a spotlight to be shone on them and not being afraid of what we find that we can go anywhere towards addressing this. We do it by establishing a blame-free culture, a bit like the airlines industry has in the HSSIB, where we look at incidents that have happened, do not blame anyone, and make sure clinicians, nurses and healthcare workers can reveal what has happened in an incident. By doing so, we can put the learnings in place to make sure that it does not happen again.

[Anne Marie Morris (Newton Abbot) (Con) [V]]

The report from Baroness Cumberlege is more than welcome. It demonstrates to me, and to many of us, that the key to getting this right is having the knowledge, because with knowledge we have power—the power to prevent something like this happening ever again. Only with that knowledge and that data can we ensure patient safety for the future, and safe innovation. In that regard, will the Minister consider going further than Cumberlege and the current medicine and medical devices legislation? We need a single database with all devices, not just those that are in vitro, and we do not need a web of connected databases; we need one. Also, we need this to be linked—we need information about devices and information about patient records connected, and those patient records must include primary and secondary care. I would like to see something that is truly integrated, internationally compatible and searchable, whether by universities, academics or the medical profession. I would like to see something that is state-of-the-art and internationally the best. To enable that, will the Minister create some form of protocol so that existing databases can in future be migrated into the master plan? At the moment, there is no plan for that. The concept is seen to be too difficult, but—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. I appreciate the importance of this statement, but please could we have shorter questions? I want to get everybody in and I think it is important that we do so.

Health Inequalities

Anne Marie Morris Excerpts

Wednesday 4th March 2020 Commons Chamber

[Anne Marie Morris (Newton Abbot) (Con)]

Good health and good healthcare are clearly the basis for happiness and prosperity for individuals and communities. As we have heard, many factors impact on health: some are personal and genetic; some are life circumstances, such as deprivation; and some are about the quantity and quality of health and care provision. But when this all comes together, we have a perfect storm. That is the plight of those who live in rural communities; my hon. Friend the Member for St Ives (Derek Thomas) alluded to that. Yet the 170-page Marmot report mentions the word “rural” only seven times, of which four are references to the Department for Environment, Food and Rural Affairs. So what do we mean by rural? It is interesting. It is not consistently defined. The Office for National Statistics, DEFRA and the Welsh Assembly all have different definitions. They are based on sparsity and deprivation, but they do not really look at the same thing. What is worse, data is analysed at a very high level. The cut-off is 15,000 heads of population. That really is not granular enough.

Density profiles look at rural towns, villages, hamlets and so on. The way they are built up, in blocks of population of 1,500, again does not really cut it. We have bizarre situations where High Peak is deemed only 55% rural, despite being right next to a national park, yet Sevenoaks, which I always thought was a big town, is 70% rural. It is very odd indeed. So there is a huge mask in the data in terms of what really is deprivation and where the need is. Therefore, the funding that is delivered to rural communities, certainly in areas such as mine, is based on the wrong assumptions. In calculating whether my constituents need money, there is a decision: do they have cars? Yes. That means they are affluent and do not need the money—wrong.

[Dr Luke Evans (Bosworth) (Con)]

Does my hon. Friend agree that patient behaviour around rurality is different from those in the city? They have to make a decision when they are on their own whether to trouble the GP, to go out, to face the weather, to go to the hospital. When they really need to go, they leave it to the last minute. That creates an inequality that is not captured in the data.

[Anne Marie Morris]

My hon. Friend is totally right. There are some very big consequentials relating to the geography of our area and to the demographic profile. We tend to export young people and import older people. In consequence, we need more geriatricians. We do not need a lot of specialists; we need doctors who can cope with complex co-morbidities. We do not have doctors like that.

We need also more funding for primary care. Much of the funding is skewed towards accident and emergency. Why? Because that is where the measures are. We also need to look at how we overcome the infrastructure barriers. Road and rail, bad; 5G, great. But we do not have it. We ought to be a priority because that would be a real plus in trying to solve this rural problem.

We also need to train and recruit people who understand rural communities. If we do not train them in rural areas, they will not want to come and stay. Nurses working in hospitals and in social care need to be trained in a similar way and they need to be interchangeable, otherwise we cannot cope with the demand in social care. On mental health, as I think has already been mentioned, isolation and loneliness in rural areas mean that we have a very high level—I think the highest level—of suicide. We have lots of lone workers and lone livers. That is a real challenge.

The consequence of all that is that in Devon we find ourselves with some of the worst financial performance results and some of the worst results in terms of meeting targets. Why? Because we are being funded for the wrong thing in the wrong way. Nobody seems to notice that many in our community do not ever get ambulances. You try north Devon and parts of Cornwall—it is just not going to happen. The effect is that we are now in special measures. What does that do? Do we get help? Actually we get told to spend less. If that is not health inequality, I do not know what is. I hope the Minister will not tell me that people in rural areas live longer. It is not great to live longer if you are not in great health and the quality of your health really does not cut it.

This situation can change and it has to change. The Government need to accept that one size does not fit all. If the Government are willing to listen and to change, it can all happen.

I invite the Minister to come and listen to the evidence I am gathering while chairing a national inquiry into rural health and care. We are unpicking the issues. We are looking at evidence not only from across the United Kingdom, but from abroad—from New Zealand, Australia and America—of what good care looks like. We hope to provide the Minister with a toolkit for a good result. Thank you for listening.

[Several hon. Members rose—]

Medicines and Medical Devices Bill

Anne Marie Morris Excerpts

2nd reading & 2nd reading: House of Commons & Money resolution & Money resolution: House of Commons & Programme motion & Programme motion: House of Commons & Ways and Means resolution & Ways and Means resolution: House of Commons
Monday 2nd March 2020 Commons Chamber

[Anne Marie Morris (Newton Abbot) (Con)]

I welcome this Bill. It is crucial that we have an effective regulatory system in this country, so we should enable the Government to amend existing regulations post Brexit. We could be a little more ambitious, however. Government time is precious, and I doubt we will have many occasions to discuss medicines and medical devices, which I suspect is why many of my colleagues have raised things that are not covered in the current legislation.

In a world in which medicines and medical devices are changing fast, the Government need to take greater powers to meet those changes and take advantage of them post Brexit. They need to be able not just to amend but to create regulations. My real concern is that the parameters of these new powers are drafted in such a way that they give power to the Government only to amend existing regulations—four sets of them. The Bill does not give the Government the power to do more, which is a missed opportunity.

Although I am conscious of the need to consider this at a European level, medicines and medical devices are, for most of us, a global issue. This Bill should not just be about ensuring we can cope after leaving Europe; it should be about the opportunity that can be created in the new global world we are entering.

A lot has been said, and rightly so, about the challenge of medical devices, which is a fast-growing area in which Britain is a leader, but it involves a huge variety of small and medium-sized enterprises, and innovation within devices is happening at a faster rate than within medicines. That is what we need to address, and I do not feel we achieve it with this Bill.

This legislation will not help with the challenges of breast implants, vaginal mesh and spinal implants that crumble, because the registry that is to be created is within the constraints and confines of existing registries that, by and large, collect information about devices. They do not collect information about the journey of those devices through the patient experience, from implant through to removal and replacement, including where the device may be defective. That information, properly recorded, would enable us not only to recall devices that we knew were faulty, but to go to patients in whom we knew a device had been implanted to expedite dealing with a medical emergency.

More importantly, medicine is about innovation and creativity. Unless we have a mechanism to evaluate the progress of medical devices implanted in individuals, how can we know which ones work and which ones do not? If a patient does not re-present, and if there is nothing added to the record, we will never know. Such a registry is mission critical.

The Government should be brave and consider a new clause to create such a registry, and they need to consider how we can consolidate the existing registries. There are many national, European and international registries for particular disease areas, and a lot of thought has been given to what best practice and the ideal registry look like. The International Medical Device Regulators Forum set out in 2016 exactly what it thought that should look like, and it seems to me that the Government would be well advised to consider that. It suggests collecting information not just about the device but about the journey through and in the patient. It seems to me that only through a change to the Bill will we achieve what we want to achieve.

Things probably go beyond that. Indeed, some of my hon. Friends have explained the complexity of understanding what a “device” is—does it include lip fillers, artificial intelligence and so on? The list of new innovations grows and will, to be honest, grow beyond current human imagination and we need a regulatory system that enables us to take advantage of that and regulate appropriately and quickly. We therefore need the capacity to change the definition of a device, and right now we do not have that because we are effectively adopting the definitions in the rules we adopted from Europe. We are giving ourselves the ability to fiddle, but not to change them fundamentally, and that is actually quite important.

We need to create an international search database so that we can deliver on some of the challenges of urgent harm, which we can prevent and deal with once a defective device is identified, and so that we can create something that gives us the opportunity to be world leaders in not only medical devices but medicines. It seems to me that that is the opportunity. Why do we constrain ourselves to being a follower? Why do we always talk about keeping up with Europe? Why not be the leaders? The National Institute for Health and Care Excellence was always set out as the global standard that everybody looked to—as absolutely what we wanted in every country. Why not have exactly the right system, whatever the NICE or the Medicines and Healthcare Products Regulatory Agency of the future looks like? Why not set the standard that others then follow?

In the earlier part of the Bill, where it covers the regulation of medicine as opposed to medical devices, there are some changes that look to the future—that is certainly the case for the changes regarding medical trials. However, it seems to me that that is a missed opportunity not only to consider the sort of regulatory system we might want in the future, but—even though we have NICE, the MHRA and notified bodies for the lower levels of medical devices, which provide CE marks— to look at this all over again. As has been said, some things that seem to be harmless and very simple, and seem simply to merit a CE mark, can become very dangerous in how they are ultimately used by a practitioner. We might need to look at all this again, but the power to do that simply is not in the Bill.

There is also nothing in the medicines section, as far as I can see, about increasing the speed of access to new developments and new medicines. That has always been a mantra of this Government, but I cannot see any provision for it. If we had control to look at the MHRA and NICE, we could do that, but as the Minister well knows the reality is that she has no power. The power to deal with the regulatory system and the regulations set by the MHRA and NICE is in the gift of NHS England. Following the Lansley reforms, that power is not now in the gift of the Government and it seems to me that the Government, who have this proactive agenda, should be taking the initiative so that they can be more direct in ensuring that we have the regulatory system we need. At the moment, all we have is the ability to limit the money that is available.

For example, the Government have talked about an innovative medicines fund, but I see nothing in the Bill to provide for that. I understand that the idea is that it can be just an extension of the cancer drugs fund, but, I ask the Minister, is that actually right? There should be different criteria—there will be different tests and different needs. Simply extending the cancer drugs fund will muddy the water and not deliver what we are really looking for, which is something that looks specifically at innovative medicines, which need clearly defining and properly clarifying. If we are to cover both groups, we need to increase the pot, but there is no suggestion of doing so.

There is a lot still to be done. Earlier, one of my colleagues made the good point that if we are to be a global leader rather than just a follower, we ought perhaps to look at how our marketing authorisations could be adopted and accepted in other countries, effectively saving costs and getting medicines to market faster. The UK would therefore be seen as the place to come for one’s marketing authorisation, rather than Europe, despite the size differential, because we would be the market leader in the mechanism to develop that.

For me, the Government have made a good start, but there is much to do. I look forward very much to the Minister’s closing remarks and, more importantly, to her confirmation that the Government have an ambitious vision and will be working hard during the following stages of the Bill’s consideration, of which I would very much like to be part, to consider changes that will deliver opportunities that the as drafted Bill does not offer. That said, it is a good start and something we can build on.